Toward Risk Stratification in Adult Extremity and Truncal Soft Tissue Sarcoma Radiation Therapy by Addition and Subtraction

Soft tissue sarcoma (STS) represents a rare group of malignancies that occur in all age groups and span multiple anatomic sites. There are many histopathologic subtypes with variable natural histories and patterns of behavior. In current STS treatment paradigms, most histologies are treated similarly, with the primary treatment modality for localized disease being oncologic resection. Pre- or postoperative radiation therapy (RT) is used to improve local control. 1 Rosenberg SA Tepper J Glatstein E et al. The treatment of soft-tissue sarcomas of the extremities: Prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982; 196: 305-315 Crossref PubMed Scopus (1062) Google Scholar , 2 Yang JC Chang AE Baker AR et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998; 16: 197-203 Crossref PubMed Scopus (1211) Google Scholar , 3 Pisters PW Harrison LB Leung DH et al. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol. 1996; 14: 859-868 Crossref PubMed Scopus (794) Google Scholar , 4 O'Sullivan B Davis AM Turcotte R et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: A randomised trial. Lancet. 2002; 359: 2235-2241 Abstract Full Text Full Text PDF PubMed Scopus (1141) Google Scholar Preoperative RT is favored in most patients given the reduction in nonreversible late effects compared with postoperative delivery. 4 O'Sullivan B Davis AM Turcotte R et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: A randomised trial. Lancet. 2002; 359: 2235-2241 Abstract Full Text Full Text PDF PubMed Scopus (1141) Google Scholar , 5 Davis AM O'Sullivan B Turcotte R et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol. 2005; 75: 48-53 Abstract Full Text Full Text PDF PubMed Scopus (505) Google Scholar , 6 Haas RL Delaney TF O'Sullivan B et al. Radiotherapy for management of extremity soft tissue sarcomas: Why, when, and where?. Int J Radiat Oncol Biol Phys. 2012; 84: 572-580 Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar , 7 Wang D Zhang Q Eisenberg BL et al. Significant reduction of late toxicities in patients with extremity sarcoma treated with image-guided radiation therapy to a reduced target volume: Results of Radiation Therapy Oncology Group RTOG-0630 trial. J Clin Oncol. 2015; 33: 2231-2238 Crossref PubMed Scopus (170) Google Scholar , 8 Salerno KE Alektiar KM Baldini EH et al. Radiation therapy for treatment of soft tissue sarcoma in adults: Executive summary of an ASTRO clinical practice guideline. Pract Radiat Oncol. 2021; 11: 339-351 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar Systemic therapy is used in select patients in an attempt to further improve recurrence and survival outcomes. 9 Gronchi A Palmerini E Quagliuolo V et al. Neoadjuvant chemotherapy in high-risk soft tissue sarcomas: Final results of a randomized trial from Italian (ISG), Spanish (GEIS), French (FSG), and Polish (PSG) sarcoma groups. J Clin Oncol. 2020; 38: 2178-2186 Crossref PubMed Scopus (103) Google Scholar ,10 Pervaiz N Colterjohn N Farrokhyar F et al. A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer. 2008; 113: 573-581 Crossref PubMed Scopus (673) Google Scholar